Oral Nifedipine in the Treatment of Chronic Anal Fissure

Abstract

Background: The purpose of this study was to demonstrate the effect of oral nifedipine on maximal resting anal pressure (MRAP) in healthy volunteers and to evaluate its role in the treatment of chronic anal fissure (CAF). Methods: MRAP was measured in 10 healthy volunteers and 10 patients with CAF before and after oral nifedipine (20 mg b.i.d.). Patients were assessed on the first visit and every fortnight for measurement of MRAP, pain scores, blood pressure, pulse rate, healing of the fissure and adverse effects. Treatments were continued until healing had occurred or for up to 8 weeks. Results: MRAP values before and after nifedipine were 73.2 and 49.3 cm H₂O, respectively, in healthy volunteers (p < 0.001). Nifedipine caused a reduction in mean MRAP from 105.2 to 74.0 cm H₂O (p < 0.001) in patients with CAF. Pain scores were significantly reduced after 2 weeks of treatment with nifedipine (p < 0.001) and continued throughout the treatment period. At the end of the study 6 of the 10 patients treated with nifedipine were deemed to be healed (n = 5) or improved (n = 1). Headache occurred in 1 patient. Conclusion: We conclude that oral nifedipine is effective in reducing MRAP and should become the first-line treatment for CAF.

A review of chronic anal fissure management

“…Oral calcium channel blockers have also been used with some success [119,[135][136][137]. A prospective study using 20 mg nifedipine twice daily reduced resting anal pressures in fissure patients and healthy volunteers [119].…”

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

“…The latter effect develops in few hours and the contraction start again within 3 or 4 months after the emergence of a new neuromuscular junction [37]. The nifedipine might be due also to its anti-inflammatory action not only to its induced reduction of the IAS tone [20,[38][39][40][41][42], carried through the inhibition of calcium flow into the sarcoplasm of IAS. Experimental studies indicate that nifedipine has a modulating effect on microcirculation [43], as well as a local anti-inflammatory effect [44].…”

Anal Fissure

“…One study evaluating oral nifedipine 20 mg twice daily resulted in healing in 60% of patients. 24 In one long-term study with 19-month follow-up, the healing rate with 0.5% topical nifedipine was 93% and healing rate with internal sphincterotomy was 100%. 25 Jonas et al performed an RCT to evaluate whether the route of diltiazem administration affects healing rates.…”